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Cochlear implant complications in Costa Rica: 11 years’ experience
Valverde Villalobos E.M. , Valverde Madriz M. , Vega Rodriguez A. , Chaverri Polini J.
Hospital Mexico, ENT, San José, Costa Rica
The national program of cochlear implants in Costa Rica is done by an otorhinolaryngology Service at Hospital
Mexico, which is part of the sole public health system: the Caja Costarricense del Seguro Social (CCSS). This
same group of surgeons is also allowed to privately perform cochlear implants surgery.
The national cochlear implant program was initiated in the year 2002 and since then, we have performed 238
cochlear implant surgeries.
In this paper, we conducted a retrospective study to evaluate the complications of cochlear implants performed
in a period of 11 years between 2002-2013. During this time, 238 cochlear implants where performed. In total,
107 were children below the age of 12, and 131 were adolescent and adults older than 13 years. From the total
patients, 99 were male and 139 were female.
The complications were classified as surgical and non-surgical. Non-surgical would include for example the
abnormal heating of the magnet in a patient post implant. The surgical complications have been further divided in
perioperative/early complications and late complications. The most common complication was the facial paresis
in 3.36%. There was one facial paralysis, representing less than 1%. A total of 6 extrusions were documented
corresponding to a 2.5% of all our patients. Out of these, 2 were in a patient who was implanted with two
different brands. We also had 4 particular cases that deserve mentioning due to failed implantation, in 3 out of
the 4 cases, we were unable to identify the cochlear canal.
We want to analyze the causes that lead to complications when performing cochlear implant surgery in a third
world country. We wish to discuss the different possible factors such as lack of experience or practice from the
performing surgeon as well as the complications not due to human error; but instead, to complications secondary
to the introduction of an artifact (cochlear implant) in humans.
The cochlear implant surgery is not exempt of complications. Nonetheless, it has been proved that it carries a
low surgical risk and low comorbidity. The cochlear implant continues to be of great benefit for patients, as
shown in this study. These characteristics encourage this particular group of surgeons to continue with the
national program of cochlear implant in Costa Rica.
The otorhinolaryngology service of Hospital Mexico is part of the CCSS, a public health entity that provides
coverage to 100% of the Costa Rican population. Therefore, it is the Hospital Mexico ENT´s service duty, to
provide service for all of the national territory. This is at the same time a university hospital, where residents are
being taught, for this reason the group of surgeons conducting the surgeries include not only attending staff but
also last year ENT residents as well.